Journal
AGING & MENTAL HEALTH
Volume 14, Issue 1, Pages 20-32Publisher
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD
DOI: 10.1080/13607860903421029
Keywords
anosognosia; insight; caregiving; Alzheimer's disease; other dementias
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Funding
- UK Economic and Social Research Council [RES-000-22-1308, RES-062-23-0371]
- Medical Research Council [GO701817]
- ESRC [ES/E012108/1] Funding Source: UKRI
- MRC [G0701817] Funding Source: UKRI
- Economic and Social Research Council [RES-000-22-1308, ES/E012108/1] Funding Source: researchfish
- Medical Research Council [G0701817] Funding Source: researchfish
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Objective: Although awareness has been extensively researched in relation to people with dementia, studies have focussed mainly on people who have dementia of mild to moderate severity. Consequently, relatively little is known about awareness in people with severe dementia, and there is no clear conceptual framework to indicate how this should be understood or investigated. Method: This review presents a conceptual framework for considering awareness in people with moderate to severe dementia which distinguishes fundamental awareness of sensory and perceptual stimuli and three levels of awareness involving more complex cognitive operations, termed 'on-line monitoring', 'evaluative judgement' and 'meta-representation', and provides an integration of the available evidence regarding each level. Results: Findings indicate that sensory and perceptual awareness can be detected even in people with very severe or end-stage dementia, while some aspects of complex awareness may be retained into the severe stages. Conclusions: The environmental context and the nature of caregiving interactions influence the extent to which awareness is expressed. There may be scope for enhancing the expression of some aspects of awareness in people with moderate to severe dementia, but this should only be undertaken where it is likely to improve quality of life. Understanding more about awareness is an important element in the provision of high-quality care for people with moderate to severe dementia.
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